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. Minnesota Lawful Gambling Lease for Pull-Tab, Paddlewheel, Tipboard, and/or Raffle Activity - LG221 Name of Legal ONner of Premises Street Address City Zip Daytime Phone ; Xi nea oli Motel Enterprifes, Inc. 55112 ( ) . . 2 1 Name of Lessor Street Address City Zip DayUme Phone (If same a51egal owner, write in "SAMEj ( ) Name of Leased Premises Street Address City Zip Daytime Phone same ( ) Name of Lessee (name of organization leasing the premises) GeB license no. of organization Daytime Phone St Mar ' s Romanian Orthodox Church ( r ) )~ P R Rent Information . Total rent cannot exceed $1,000 per month for all . An organization may not pay rent to itself or to non-bingo activity for this premises. any of its affiliates for space used for the conduct . For bingo activity, use lease form LG222. of lawful gambling. . For pull-tab dispensing machines, use lease form LG223. Rent to be paid per month $ 1,000. (If no rent is to be paid, indicate-O-) Sketch and Dimensions of Leased Area Sketch: For all areas being leased for the conduct FPPR~~TiS"#'.~'~.~i~"~~.~~~'i'~~piiS~~~9'#9.~!1!::!'i'n~: of gambling and storage of gambling product at this Ch~9g<;s have beertrnada'a:lthe site;'YOUd~not hav~tcil premises, attach a sketch (drawing) showing: (1) the com pletetl1i"s"cii~ n.or pr~:;;i de a sketch,.; ::;}i' .~j. leased area(s), and (2) the dimensions. ""'...;'" ....:..:'.'.... ..--.'..', ':.' .:'.'.',..:-,/"." .....::,'<.>,....."..-.:..::',.,. :..':':. '..:.:,::-.-:..:::::,"". .:'.' .....' :::'~ Dimensions The leased areas are: 7 feet by 8 feet for a total of 56 square feet. . feet by feet for a total of square feet. feet by feet for a total of square feet. . ; Storage feet by feet for a total of square feet. Storage feet by feet for a total of square feet. Combined total 56 square feet. Lawful Gambling Activity Type of gambling activity that will be conducted at this gambling premises, Check all that apply. Paddlewheels XX Pull-Tabs Raffles Tipboards Term of Lease Amended Lease Only The term of this lease agreement will be concurrent with the If this is an amended lease showing changes occurring dur- premises permit issued by the Gambling Control Board, ing the term of the current premises permit, write in the unless terminated sooner by mutual consent of the lessor date that the changes will be effective ----1----1_, and lessee. Both parties that signed the lease must initial and date all changes. . Questions on this fonm should be directed to the Licensing The infonmation requested on this form will be used by the' Section of the Gambling Control Board at (612) 639-4000, Gambling Control Board (Board) to determine your compliance This publication will be made available in alternative format with Minnesota statutes and rules governing lawful gambling (i.e. large print. Braille) upon request. Hearing impaired activities, All of the information that you supply on this fonm , individuals using a TTY may call the Minnesota Relay Service will become public information when received by the Board . at 1-800-627-3529 and ask to place a call to (612) 639-4000. except, if required, your Social Security number, which remains " . private.